Neuropathy isn’t a single condition. It’s an umbrella term for nerve damage that takes many forms depending on which nerves are affected, what caused the damage, and how many nerves are involved. The broadest categories are peripheral, autonomic, proximal, and focal neuropathy, but within those groups are dozens of specific subtypes with different causes, symptoms, and outlooks. About 2.4% of the general population has some form of peripheral neuropathy, and that number climbs above 8% in people over 55.
Peripheral Neuropathy
Peripheral neuropathy is the most common type overall. It damages the nerves in your arms and legs, almost always starting in the feet and working upward before reaching the hands. You might hear it called distal symmetric polyneuropathy, which just means it affects both sides of the body in a pattern that starts farthest from the spine and moves inward.
The hallmark symptoms are numbness, tingling, burning, and pain in the feet and toes. Over time, you may lose the ability to feel temperature changes or small injuries, which is why foot ulcers and infections are a serious concern. Some people also develop weakness in the affected limbs, making it harder to grip objects or maintain balance. Diabetic peripheral neuropathy is the single most common form, accounting for 32% to 53% of all neuropathy cases. Up to half of all people with diabetes develop some degree of nerve damage.
Autonomic Neuropathy
Where peripheral neuropathy targets the nerves you use to feel and move, autonomic neuropathy damages the nerves that run your organs behind the scenes. These are the nerves controlling heart rate, blood pressure, digestion, bladder function, sweating, and sexual response.
The symptoms can be confusing because they don’t feel like “nerve problems” in the way most people imagine. Your heart rate might not speed up during exercise, leaving you exhausted after mild activity. You could feel full after just a few bites of food, develop unexplained bouts of diarrhea or constipation, or have trouble sensing when your bladder is full. Sweating abnormalities are common too: some people sweat excessively while others barely sweat at all, making it difficult to regulate body temperature. Because the symptoms overlap with so many other conditions, autonomic neuropathy often goes undiagnosed for years.
Proximal Neuropathy
Proximal neuropathy strikes closer to the trunk of the body, typically causing sudden, severe pain in the hip, buttock, or thigh on one side. It’s sometimes called diabetic amyotrophy or diabetic polyradiculopathy. Unlike peripheral neuropathy’s slow creep from the toes upward, proximal neuropathy can hit hard and fast.
The pain is often the first and most noticeable symptom, but weakness follows. People with proximal neuropathy frequently struggle to stand up from a seated position because the thigh muscles lose strength. Over time, the affected muscles can visibly shrink, a process called muscle wasting. Weight loss and loss of reflexes (like the knee-jerk response) are also typical. This type is less common than peripheral neuropathy but can be more disabling in its early stages.
Focal Neuropathy
Focal neuropathy, also called mononeuropathy, damages a single specific nerve rather than a widespread group. It appears suddenly and can strike in the head, torso, arm, or leg. The most familiar example is carpal tunnel syndrome, where a nerve at the wrist becomes compressed, causing pain, numbness, and tingling in the thumb, index finger, and middle finger. About 25% of people with diabetes have some degree of nerve compression at the wrist, even though fewer than 10% feel noticeable symptoms.
Other common focal neuropathies include ulnar nerve entrapment, which causes numbness and tingling in the ring and little fingers, and Bell’s palsy, a cranial neuropathy that temporarily paralyzes one side of the face. Focal neuropathies tend to resolve on their own over weeks to months, though the experience can be alarming when symptoms appear without warning.
Autoimmune and Inflammatory Types
Some neuropathies are caused by the immune system attacking the body’s own nerves. The two most recognized forms are Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP).
GBS comes on fast. It’s characterized by rapid-onset numbness and weakness that typically starts in the fingers and toes and climbs toward the torso over days. In severe cases, the paralysis reaches the breathing muscles. GBS reaches its worst point in less than four weeks and is considered a medical emergency. Most people recover, though the timeline varies from weeks to months.
CIDP is essentially the chronic version. It develops more slowly, taking at least eight weeks to reach its most severe state, and it follows a course of gradual worsening rather than a sudden crisis. Both conditions involve the immune system stripping away the protective insulation around nerves (called myelin), though GBS can also directly damage the nerve fibers themselves. Loss of reflexes is a key diagnostic sign in both.
Hereditary Neuropathies
Not all neuropathy is acquired. Charcot-Marie-Tooth disease (CMT) is the most common inherited form, affecting roughly 1 in 2,500 people. It’s actually a family of related conditions, grouped by how they damage nerves.
CMT type 1 damages the myelin sheath, the insulating layer that helps nerve signals travel quickly. About 70% to 80% of type 1 cases trace back to an extra copy of a single gene on chromosome 17. CMT type 2 damages the nerve fiber itself rather than the insulation, which weakens the nerve signal. Type X is linked to mutations on the X chromosome, meaning it follows a sex-linked inheritance pattern and tends to affect males more severely. Type 4 is the rarest and can damage either the myelin or the nerve fiber directly.
All types of CMT cause progressive weakness and loss of sensation, usually starting in the feet and lower legs during adolescence or early adulthood. The condition worsens slowly over decades.
Neuropathy From Nutritional Deficiencies
Several vitamin deficiencies can directly damage nerves. Vitamin B12 deficiency is the most widely known, but B1 (thiamine), copper, and vitamin E deficiencies all cause distinct patterns of nerve damage.
Thiamine deficiency produces what’s sometimes called “burning foot” syndrome, an acute or subacute neuropathy dominated by painful burning sensations. In severe cases, it can also cause weakness in the facial muscles and tongue. Copper deficiency tends to damage both the spinal cord and peripheral nerves simultaneously, a combination called myeloneuropathy.
Vitamin B6 is unusual because both too little and too much can cause neuropathy. Deficiency causes nerve damage, but people taking high-dose B6 supplements (as little as 200 mg per day, far above the 2 mg recommended daily amount) have developed burning sensations and balance problems from excess B6. This makes it one of the few vitamins where supplementation itself can be the problem.
Chemotherapy-Induced Neuropathy
Chemotherapy-induced neuropathy affects roughly half of all patients undergoing cancer treatment. Certain classes of chemotherapy drugs are particularly likely to cause nerve damage, and the risk increases with higher cumulative doses. Symptoms mirror peripheral neuropathy: numbness, tingling, and pain in the hands and feet. For some patients, the neuropathy resolves after treatment ends. For others, it becomes a permanent side effect that outlasts the cancer itself.
How Doctors Tell Them Apart
Because neuropathies can look similar on the surface, diagnosis often requires electrical testing of the nerves. Nerve conduction studies measure how fast electrical signals travel through different nerves in the body. Slow conduction speeds, along with specific changes in the signal waveform, point toward damage to the myelin insulation. When the nerve fibers themselves are damaged instead, conduction speed stays relatively normal but the strength of the signal drops.
Electromyography (EMG) complements this by measuring how muscles respond to nerve signals. Together, these two tests help distinguish between demyelinating and axonal neuropathies, which is critical because the distinction often determines the underlying cause and guides treatment. For small fiber neuropathies that don’t show up on standard electrical tests, a skin biopsy can reveal damage to the tiny nerve endings in the skin.